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[Update on recommendations for screening for hydroxychloroquine retinopathy].

A Couturier1, A Giocanti-Aurégan2, B Dupas1

  • 1Service d'ophtalmologie, hôpital Lariboisière, DHU vision et handicaps, université Paris 7-sorbonne Paris cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.

Journal Francais D'Ophtalmologie
|October 22, 2017
PubMed
Summary

Chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy risk is low at recommended doses but increases with long-term use. Annual screening starting year five is recommended, using visual field and OCT tests.

Keywords:
Antipaludéens de synthèseChloroquineHydroxychloroquineMaculopathieMaculopathyRetinal toxicityRetinopathyRétinopathieSynthetic antimalarialsToxicité rétinienne

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Area of Science:

  • Ophthalmology
  • Pharmacology
  • Retinal Diseases

Background:

  • Recent changes in American Academy of Ophthalmology guidelines for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy screening.
  • Updated understanding of toxicity prevalence, risk factors, retinal onset location, and screening test efficacy.

Purpose of the Study:

  • To review current recommendations for screening CQ/HCQ retinopathy.
  • To outline risk factors and appropriate screening protocols.

Main Methods:

  • Comprehensive literature review.

Main Results:

  • Retinopathy risk is dose and duration-dependent, with <1% risk at 5 years and <2% at 10 years at recommended doses (HCQ ≤5.0mg/kg, CQ ≤2.3mg/kg).
  • Risk increases significantly after 20 years of treatment.
  • Key risk factors include daily dose, treatment duration, kidney failure, and tamoxifen use.

Conclusions:

  • Baseline examination is crucial before treatment initiation.
  • Annual screening should commence at year five, utilizing automated visual fields and spectral domain OCT.
  • Multifocal ERG and fundus autofluorescence are secondary confirmatory tests.